Snelling Journal of International Humanitarian Action (2018) 3:14 Journal of International https://doi.org/10.1186/s41018-018-0042-7 Humanitarian Action

RESEARCH ARTICLE Open Access The impact of emergency aid work on personal relationships: a psychodynamic study Mark Snelling1,2

Abstract Humanitarian organisations and researchers have paid increasing attention in recent years to the psychological wellbeing of aid workers. This attention, however, has tended to focus more on the practicalities of stress management and resilience than on the deeper levels of their relational lives. This qualitative research study explored the conscious and unconscious impact of emergency aid work on the personal relationships of those who deliver it. Six experienced staff members of an international non-governmental organisation (INGO) were invited to reflect freely on their relationships in unstructured interviews. Using psychoanalytic theory, the data were analysed for both surface and hidden content. Every participant identified the significant external split that aid work created between home life and the field and described conscious strategies to manage this challenge. Their narratives, however, also indicated deeper inner dilemmas along with more unconscious strategies for protecting themselves against the anxiety generated by those dilemmas. Although deployed in response to the relational demands of the work, these strategies also appeared to form part of patterns of relating developed prior to entry into the sector. The study concluded that structured spaces where humanitarians can reflect on these issues would be beneficial both to personal resilience and to organisational effectiveness. Keywords: Humanitarian aid worker, Relationships, Trauma, Psychodynamic, Psychosocial support

Introduction and rationale nature of most assignments, especially for those who spe- There is an old joke in the humanitarian aid sector that cialise in emergency response, results in a transient lifestyle those who work in it are either “misfits, mercenaries or that poses particular risks to the maintenance of consistent missionaries” (Silverman 2005). Making light of the com- support structures (McKay 2007). Without these structures, plex mix of motives that draw people into the field may both research (Cardozo et al. 2012; Ozbay et al. 2007)and alleviate some of the stress of a very challenging environ- anecdotal evidence in the field demonstrate that it can be ment. The joke, however, also points to a recognition that very difficult to maintain resilient functioning. the choice of career can involve a great deal more psycho- The motivation for this study has arisen from my own logical and emotional complexity than a straightforward de- experiences of humanitarian field work in Africa, Asia and sire to help the world’s poor and dispossessed. Few jobs are the Middle East, first as a delegate of the British Red Cross as “all-encompassing” (Fechter 2012b) as international hu- Society (BRCS) from 2000 to 2007, and subsequently as a manitarian work, requiring people to live far from their psychosocial consultant. In both capacities, I have ob- homes and families, often lodged in close proximity to their served that the struggle to maintain viable relational sup- colleagues while exposed to traumatic events, traumatised port structures is commonplace, consuming a lot of time individuals, or both. At the same time, the short-term and emotional energy. As a clinician, I have also been re- peatedly struck by how often my humanitarian clients cite relational difficulties, not exposure to trauma, as a primary Correspondence: [email protected] 1Department of Social and Political Science, University of Chester, Parkgate source of distress in the field. Even work with those specif- Road, Chester CH1 4BJ, UK ically presenting for trauma treatment seems often to link 2Mark Snelling Therapy, Parkshot House, 5 Kew Road, Richmond, Surrey TW9 to problematic relationships. Yet while there is a 2PR, UK

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Snelling Journal of International Humanitarian Action (2018) 3:14 Page 2 of 15

substantial body of research on stress management, resili- relationships in order to identify potentially ence and trauma care for aid workers (see “Literature re- underexamined areas and, as a result, provide a view” below), little specific academic attention has been focussed framework for this study. directed towards their relational worlds.  To identify and outline the key relational challenges Further research, along with exploration of these ques- described by study participants, with a particular tions in personal therapy, have also prompted me to ques- focus on the ways in which these challenges register tion whether these difficulties are purely a consequence of in their inner emotional and psychological worlds. working in aid or are, at times, a manifestation of personal  To use psychoanalysis and attachment theory as a relational templates that pre-date people’s entry into the framework for conducting an in-depth exploration sector. And while other helping professions, such as coun- of the unconscious psychological strategies deployed selling, social work and nursing consider reflection on the by study participants to manage and cope with these personal aspects of practitioners’ lives to be a critical com- challenges. ponent of ethical practice (Hawkins and Shohet 2012), for-  To draw out practical measures that humanitarian mal processes that would facilitate this are strangely workers and organisations could implement to help missing in humanitarian aid (Fechter 2012b). them cope with the relational demands of the work. In seeking to address these questions, this study is grounded in psychodynamic1 theory, the body of thinking It is important to state at the outset that this study was pioneered by Freud that suggests people protect them- based on interviews with expatriate aid workers and as selves from anxiety by pushing unacceptable thoughts, such does not reflect the relational experience of nation- wishes and feelings out of conscious awareness (Freud ally hired staff, who work in their home countries, or 1915/1968b). Advances in contemporary psychoanalysis non-Western expatriates. There is no doubt that the men- have also placed increasing emphasis on the ways in which tal health of national staff demands more attention than it these unconscious anxieties can exert a powerful and po- receives (Ager et al. 2012; Porter and Emmens 2009). tentially problematic influence over people’scurrent While consideration of the impact on local workers is be- relationships (Lemma et al. 2011; Mitchell 2000;Stack yond the scope of the present study, it is hoped that the Sullivan 1968). Finally, psychodynamic workplace research psychodynamic approach taken here to examine expatri- indicates that a failure to address these individual anxieties ate experience could open future avenues of research to can lead to significantly wider dysfunction in organisa- include all staff groups. It is also hoped that the present tional dynamics and performance, especially in the helping study will initiate a more active debate over whether an in- professions (Obholzer and Zagier Roberts 1994). creased understanding and care for the internal psycho- While the sector routinely debates how it needs to adapt logical and emotional worlds of aid workers, expatriate to external political, economic and sociological factors and local, could benefit the overall effectiveness of the glo- (Inter-Agency Regional Analysts Network [IARAN] 2017) bal humanitarian project. in the face of widespread criticism of its perceived failings (de Waal 1997; Easterley 2007;Moyo2010;Riddell2008), Literature review the present study seeks to focus on what might be learned The evolution of today’s international humanitarian sys- by attending to the internal relational worlds of humani- tem can be characterised by a multitude of social, eco- tarian workers. It could be argued that recent scandals in- nomic and political factors, but certain key developments volving sexual misconduct among expatriate aid workers stand out; the massive post-World War II proliferation of (Dodds 2017;O’Neill 2018) have added urgency to the agencies, the broadening global reach of humanitarian ac- need for humanitarian workers and their organisations to tivity and the emergence of so-called complex emergencies understand and monitor interpersonal needs and how in the 1990s (Davey et al. 2013). As the work of humani- they get met. Further research is needed on the specific tarian aid became ever more complex, demanding and links between individual anxiety and organisational dy- dangerous, researchers began to turn their attention not namics in the humanitarian sector, but the present study just to the sector itself, but to the people who worked in it will focus on the conscious and unconscious impact of (Slim 1995). humanitarian work on the relationships of those who Most academic studies on aid workers (see below), undertake it. At the same time, it will also consider the along with a range of guidelines and manuals issued over potentially pre-existing patterns of relating that they may the years (e.g., Antares Foundation 2012; Macnair 1995; be bringing into the profession in the first place. People in Aid 2003), have focussed on the operational The central aims of the present study were as follows: challenges of stress management and the resilience strat- egies available in response to highly demanding environ-  To explore the literature on humanitarian aid ments. These will be considered first before turning to workers with particular attention to personal the small but expanding literature over the past 10 years Snelling Journal of International Humanitarian Action (2018) 3:14 Page 3 of 15

on the more subjective thoughts and feelings of aid management manuals for aid workers. In 2004, the workers (including personal motives). It will then be publication of the “Guidelines for Good Practice: considered how the wider psychodynamic literature on Managing Stress in Humanitarian Workers” (Antares attachment might help deepen an understanding of the Foundation 2012), a collaboration between the Antares relational patterns of those who work in the humanitar- Foundation in the Netherlands and the Centers for ian sector. Disease Control (CDC) in the USA, represented a new level of conceptual sophistication in humanitarian staff The birth of stress management care frameworks. As occasional articles and chapters Following the end of the Cold War in 1991, an apparently (Danieli 1996) on the welfare of aid workers became more peaceful international environment quickly gave way whole books devoted entirely to this area (Ehrenreich to a surge in particularly destructive conflicts in places 1999), it seemed that the physical and psychological health such as Liberia, Sudan and the former Yugoslavia, charac- of humanitarians had become established as a discrete do- terised by substantial loss of civilian life, massive displace- main of research and study. An initial focus on practical ment of populations and decimation of social and stress management, however, was soon to evolve. economic structures (Duffield 1994). While the humani- tarian sector rushed to adapt logistically to the large-scale, Towards resilience multi-pronged responses now required (Davey et al. Outside the humanitarian sector, the 1990s onwards saw a 2013), voices within the sector began to consider the pos- shift in the psychology literature from a concentration on sible impact on the people delivering the assistance. In a risk factors, namely the causes and symptoms of psycho- seminal conference paper (1995), Hugo Slim set out what logical distress, towards a greater strengths-based focus he felt were the new skills for aid workers that these on how people maintain emotional and physical resilience “radically different” (p. 2) emergencies would require, in the face of adversity (Cyrulnik 2009; Reich et al. 2012; including negotiation and conflict analysis. Although Slim Seligman 1990). An early study on resilience in the hu- only made brief mention of the emotional needs of aid manitarian arena (Berk 1998) examined the way in which workers, his paper was representative of a new interest in both child victims and aid workers in Bosnia drew on very the lives of humanitarians themselves, alongside those of similar strategies, such as cognitive restructuring, to sup- the beneficiaries of aid. port resilient coping. Later studies (Ehrenreich and Elliott A year later, the Overseas Development Institute (ODI) 2004; Eriksson et al. 2001) identified the need for organ- published a report (Macnair 1995) commissioned by a isational inputs such as training and on-going support to group of agencies looking at levels of organisational sup- promote and bolster the individual resilience strategies of port for expatriate aid workers. As the title “Room for aid workers. Researchers also began including the role of Improvement” suggested, the report uncovered weak- spirituality (Blanchetiere 2006)andreligiousfaith nesses across a range of human resources management (Eriksson et al. 2009) in supporting resilient functioning. practices in the sector, leading to both poor performance The first major longitudinal study of the mental health of by staff and a reduction in the quality of programmes humanitarian workers (Cardozo et al. 2012)confirmed (Macnair 1995). The report fed into a much larger project, that workers with access to robust support structures, culminating in the publication 2 years later of the “People such as reliable friendship groups, coherent teams and ac- In Aid Code of Best Practice in the Management and cessible psychological services, were less vulnerable to Support of Aid Personnel” (People in Aid 2003), aimed at depressive illness and burnout. In the light of chronic equipping managers and human resources advisors. Like exposure to acute stress, however, researchers confirmed much of the writing at the time, the report focused mainly that aid workers experienced higher levels of on practical occupational health challenges but did not trauma-related mental illness (Connorton et al. 2012)than consider the emotional or relational challenges. In 1998, other professional groups and were particularly vulnerable the stress management unit of the International Commit- to burnout (Pigni 2016). As such, efforts continue to iden- tee of the Red Cross (ICRC) published its findings tify effective self-care and organisational support strategies (de Haan 1998) on the impact of psychological debriefing (Dunkley 2018; Quevillon et al. 2016). on returning workers and a year later, the British Medical Journal (BMJ) featured an article (McCall and Salama Subjective experience of aid workers 1999) on the selection, training and support needs of aid Writing on the more personal, subjective experience of workers, noting that their mental health and the impact of aid workers first emerged mainly in memoirs of life in their work was still relatively unstudied. At around the the field, offering colourful, first-person accounts of the same time, the ICRC (de Haan 2001) along with the dilemmas and disillusionments of the work (Cain et al. United Nations (UNHCR 2001) and other large agencies 2005; Orbinski 2008; Vaux 2001). These were later (Fawcett 2003) began releasing more comprehensive stress joined by a multitude of blogs ranging across a broad Snelling Journal of International Humanitarian Action (2018) 3:14 Page 4 of 15

spectrum of both content and quality. Popular examples psychoanalytic texts. A search of the PsycINFO database include Aid Leap (https://aidleap.org), Stuff Expat Aid using the terms “humanitarian” and “psychodynamic” Workers Like (https://stuffexpataidworkerslike.com) and yielded only one article (Karray et al. 2017) looking at the 50 Shades of Aid (https://www.facebook.com/groups/ dynamics of online support to field staff. While there is a 1594464844163690). well-established psychodynamic literature on refugees and An early academic study (Bjerneld et al. 2006)ofthe the victims of humanitarian crises (Alayarian 2011; Papa- psychological dynamics of aid workers focused on motiv- dopoulos 2002; Volkan 2017), there is very little published ation, identifying a range of drivers ranging from an altru- research into the unconscious dynamics that might be at istic desire to help others to a wish to feel personally play among aid workers. needed and fulfilled. A later study (Tassell and Flett 2007) The motivation to undertake psychodynamic research considered humanitarian activity in the light of into the impact of aid work on personal relationship arises, Self-Determination Theory (Deci and Vansteenkiste 2004), therefore, from what appears to be the relative neglect of a a broad framework for examining human motivation. central area of their experience, both in the research litera- Drawing on the concept of “harmonious and obsessive ture and in the stress management and resilience informa- passion” (Vallerand et al. 2003), the study (Tassell and tion distributed by organisations. Anecdotal evidence Flett 2007) explored two potential motivational forces in gathered from personal experience in the field, first-person aid workers, one that represented a freely chosen desire to written accounts of field life and substantial clinical experi- work in harmony with personal values and self-perception ence all indicate high levels of relational distress among and another driven by a more obsessive need to acquire a those who do this work, especially when it comes to main- sense of social acceptance or self-esteem. The study taining an intimate partner relationship. Yet much of the (Tassell and Flett 2007) made an important contribution published advice given to humanitarians on life in the field to the understanding of humanitarian resilience in its remains strangely silent on this issue. finding that individuals driven by obsessive passion were likely to continue in the work even when it became detri- Methodology mental to their wellbeing, thus significantly increasing the The research was conducted using the Free Association risk of burnout. Narrative Method (Hollway and Jefferson 2013), a psycho- Although neither of the above-mentioned studies drew dynamically oriented methodology aimed at capturing on psychodynamic theory, they signalled a curiosity both conscious and unconscious aspects of experience. about the unconscious forces that may be at work in aid Freud believed that the need to suppress undesirable emo- workers’ lives. This has been accompanied in more re- tions resulted in the creation of a part of the self that faces cent research by more nuanced examinations of deeper out to the world—the ego—and an inner less conscious emotional reactions to exposure to conflict, including part that is subject to powerful instincts and drives—the self-doubt, shame and isolation (McCormack and Joseph id Freud (1917/1957). This psychic structure is then 2013), along with more focussed attention on the role of maintained by a series of defences that protect the self interpersonal networks in supporting the resilience of against anxiety Freud (1968a, 1968b/1915/b), including re- humanitarian workers (Thomas 2016). It is also only in pression (Freud 1968b/1915/b), a process as noted previ- recent years that studies have begun to consider not just ously whereby unacceptable psychic content is ejected the impact of the work on field staff, but pre-existing from consciousness. In splitting (Freud 1940), the mind factors and traits, such as childhood trauma (Eriksson et separates what is seen to be threatening and destabilising al. 2013), a need for self-reliance and a reluctance to from what appears to be nourishing and supportive in seek help from others (Skeoch et al. 2017). order to protect what is good from being overwhelmed by Although research on humanitarian workers themselves the bad. And in projection (Klein 1946), emotional parts seems to be expanding and deepening, anthropologists of the self that are deemed to be unacceptable are then have identified the striking lack of attention given to the pushed into the outside world and attributed to other personal aspects of aid workers’ lives by training institu- people. tions and organisations, especially given the importance Klein (1946) based her theory on close observation of assigned to personal considerations in other helping pro- the ways in which young infants evacuate feelings of fessions such as counselling, nursing and social work rage and helplessness into the mother as a way of man- (Fechter 2012b). Although studies seem to be implicitly aging otherwise unbearably vulnerable internal states considering the more unconscious aspects of aid workers’ (Berzoff and Kita 2010). The psychoanalyst Wilfred Bion minds, psychodynamic approaches to this area are again (1959) extended Klein’s thinking by considering how striking in their absence. Berk’s previously cited study anxious adults, also, will non-verbally expel overwhelm- (Berk 1998) of aid workers in Bosnia is the only article on ing feelings into others as both a way of stabilising humanitarians in the entire PEP-Web database of themselves, but also as a primitive form of Snelling Journal of International Humanitarian Action (2018) 3:14 Page 5 of 15

communication, transmitting important information to other than her home country that she had chosen to make the listener that can be picked up and received (Hinshel- her base between missions. Three of the participants wood 1991). Bion (1962) observed that if the mother is spoke English as a first language, two were bilingual and able to take in and make sense of those anxieties before one spoke English as a second language. reflecting them back to the infant in a more manageable In terms of socio-cultural context, all the participants form, a process he described as containment,thebabyis were situated within the Western expatriate culture of the then able to return to a state of calm. For adults, the same global humanitarian sector. While two participants came principle can be applied to the way that counsellors, psy- from families with at least one non-Western parent, the chotherapists and supervisors help adults by actively lis- conversations with all participants were framed by con- tening to their potentially overwhelming experiences cerns consistent with a more individualised Western before reflecting on them in a way that makes them more worldview, such as the importance of self-expression (Kim bearable (Casement 2014). The idea of containment has and Sherman 2007). Care was taken not to make general- also been used by organisational theorists (Obholzer and ised assumptions about the participants, who described a Zagier Roberts 1994) to explore the ways in which groups variety of diverse priorities, personal values and experi- and organisations can manage and process the anxieties of ences, but it is important to state that they did so from those who work within them, as well as the difficulties that within a relatively homogeneous socio-cultural frame. It arise in terms of team dynamics when those unconscious should also be noted that the psychoanalytic methodology anxieties are not identified and dealt with. used in the present study is also grounded in a Western In order to tune into and pick up this kind of clinical tradition that has been slow to pay full attention non-verbal communication, the interviews themselves to the impact of social, ethnic and cultural influences on were conducted using a core technique drawn from psy- people’s inner worlds (Tummala-Narra 2015). Having said choanalytic psychotherapy for accessing unconscious ma- that, there is an expanding literature examining the terial described by Freud as free association (Breuer & cross-cultural applications of psychoanalysis (Alayarian Freud, 1895/1955). It was explained to participants that 2011) and attachment theory (Agishtein and Brumbaugh the interview would be unstructured, and they were in- 2013;ErdmanandNg2010;Mesmanetal.2016). In the vited to speak in an uncensored way about whatever came final analysis, however, the present study is authored by a to mind in relation to the research question. Little guid- western researcher focussing on the inner experience of a ance was offered regarding any expected content, and lit- small group of western or westernised aid workers. As tle intervention was offered by the researcher during the noted previously, the aim is to initiate further discus- interview. Once collected, the interviews were then ana- sion and research and caution is needed in generalising lysed not just for manifest content, but also for inconsist- the findings. In particular, further cross-culturally ori- encies, contradictions, slips of the tongue and body ented research would be needed before applying its language. Psychoanalytic theory contends that all of these findings to non-Western humanitarian staff, both ex- factors can be read as indicators of unconscious content patriate and national. (Hollway and Jefferson 2013). Several participants, for in- A brief summary of each participant is provided below stance, lost fluency in otherwise verbally coherent narra- (Table 1). tives when they tried to speak about the challenge of maintaining intimacy, potentially signalling unconscious Reflexive statement blockages in engaging with this aspect of their lives. The Alongside the participants’ narratives, the methodology technique, then, offers insight into hidden dynamics and takes a position that the researcher’s own experiences, motivations that would never be visible in either quantita- thoughts and feelings can also provide context and tive research or more face-value types of qualitative work insight into the participant’s material in a way that yields (Frosh and Saville Young 2008). accurate and valuable information (Holmes 2013). In this case, my own knowledge and personal experience of the sector, combined with insights from personal therapy Participants and clinical experience were included as anecdotal evi- The six participants in the research were all professional dence in support of the study’s findings. aid workers, drawn from the emergency roster of a large In terms of autobiographical context, I spent many International Non-Governmental Organisation (INGO). years in the field, first as a journalist and then as an ex- Aged between their early thirties and early sixties, four patriate humanitarian aid worker. Having suffered from participants were women and two were men. Two were major depression for many years, I made the decision to currently deployed in the field, two were back in their return to my home country, the UK, and undertake home countries on leave between assignments, one had long-term psychoanalytic psychotherapy. Having bene- taken time out from field work, and one was in a country fited significantly from the process, I then re-trained as a Snelling Journal of International Humanitarian Action (2018) 3:14 Page 6 of 15

Table 1 Summary of participants Namea Biographical details Psychosocial formulation Julian Senior manager with 20 years of field experience, married with Presented as confident and securely attached but acknowledged a stable home base. internal conflicts and high personal cost of the work. Thomas Senior manager with 25 years of field experience, in a long-term Presented as calm and measured. Although he described himself as “open” relationship approachable, he evidenced traits of an avoidant attachment styleb Jane Had taken a mid-career break from the field in order to reflect on Presented as active and engaged but somewhat anxious. Had used her life and build a more stable home base. Described a close circle counselling to try and work through a perceived struggle to integrate of female friends but no partner. different areas of her life. Anna Was currently on deployment, away from a secure home base and Presented as calm and level-headed but concerned by a sense that long-term partner. field work is incompatible with longer-term family life. Evidenced avoidant attachment traits. Emma Experienced senior manager, currently between deployments. Presented as confident and assertive but indicated high levels of Married with children having established a home base in an frustration with the difficulties of adapting to life outside the field. adopted country. Indicated anger at having been assigned a coping role in family of origin. Sara Experience practitioner based at HQ with frequent travel to the Presented as a motivated and principled individual, with strong field. Described global friendship circle but no partner. beliefs in personal autonomy. Also evidenced avoidant attachment traits and had sought counselling to explore continuing lack of intimate partner relationship. aAll names of participants have been changed to protect anonymity bSee “Attachment styles” section for definitions and discussion psychotherapist myself. Many years of personal reflec- In addition to the contextual knowledge, the data were tion and therapy yielded an understanding that while my also analysed through the filter of my own emotional re- decision to enter the humanitarian sector had indeed been actions to the narrative, understood in psychoanalytic motivated by an altruistic wish to make a difference in the terms as “counter-transference” (Heimann 1950), or the world, it had simultaneously been driven by a powerful receipt of unconscious projections from the participant. but unconscious wish to manage and master anxieties This further elaborated and deepened an understanding stemming from attachment disruptions much earlier in of the participant’s “total situation” (Joseph 1985), a psy- childhood. Working as a humanitarian had, in part, en- choanalytic concept denoting a full understanding the abled me to disown unbearable feelings of vulnerability way an individual’s patterns of relating are transferred and locate them externally in the so-called beneficiaries of from the past to the present. These diverse strands were the aid that he was helping to deliver. In relational terms, then gathered into an overall psychodynamic formula- it also manufactured a sense of interpersonal proximity tion regarding the impact of aid work on the relational while avoiding the perils of genuine intimacy. lives of the participants incorporating both conscious In undertaking this study, then, I identified a clear risk and unconscious aspects of their narrative. that I might only look for validation of my own experi- ence. The alternative, however, was to fully declare my Limitations own experience and use it as a tool and a guide, a stance While the psychoanalytic method has the potential to illu- known as researcher reflexivity (Etherington 2004). Ether- minate the unconscious dynamics that exist behind partic- ington (2004, p. 31) defines reflexivity as “the capacity of ipants’ presenting positions (Frosh and Emerson 2005), it the researcher to acknowledge how their own experience could be argued that the findings of a psychoanalytically and contexts (which might be fluid and changing) inform oriented interview are “inevitably and intrinsically the the process and outcomes of inquiry”. Far from blinding product of the particular researcher-interviewee dyad” me, this stance closes what she calls the “illusory gap be- (Holmes 2013). Given that the counter-transference reac- tween researcher and researched” (Etherington 2004,p. tions of any researcher will be determined by the inter- 32), creating “a relationship with participants … of con- action between the projections of the participant and sultancy and collaboration” (Etherington 2004,p.32), specific elements of his or her own inner world, it is quite which in turn generates an interactive energy in re- possible that another researcher could experience those search interviews that can yield accurate and valuable projections differently and therefore draw different con- information. In simple terms, I undertook this study clusions. Efforts have been made in the present study, backed by substantial experience of the sector, experi- therefore, to adhere to quality indicators of transparency ence which I used “for the purpose of extending and reflexivity to ensure that readers are able to see clearly sociological understanding” (Wall 2008,p.38)ofmy where interpretations and conclusions have been drawn subject matter. from these interpersonal dynamics. Snelling Journal of International Humanitarian Action (2018) 3:14 Page 7 of 15

It could also be argued that aid workers who are more Participants cited a range of concrete, external chal- likely to have experienced relational challenges as a re- lenges generated by this split, including finding and sult of their jobs will have self-selected to participate in maintaining an intimate relationship, maintaining a cir- this study. Again, however, their narratives were analysed cle of friends, establishing and maintaining a physical in the context of the author’s own experience of the sec- home base and managing the amount of time spent in the tor, both as a worker himself and as a clinician support- field versus time needed at home. In terms of finding a ing humanitarian staff. So while caution is required in partner relationship, the two male participants had found generalising the findings of the study, it can be argued apparently stable but different solutions. Julian had mar- that the multiple strands of contextual data that frame ried a local woman in the African country where he was the participants’ accounts generate an “enrichment of in- first assigned. Thomas, the oldest of the participants, had terpretive understanding” (Frosh and Emerson 2005,p found the answer in agreeing to an “open” arrangement 308), providing in turn a solid basis for tentative but reli- with his partner back home. Both men expressed satisfac- able conclusions. tion in the stability that these relationships provided them amidst the frequent travel of their working lives. The picture for the two women in long-term partner- Findings ships seemed more complicated. Jane barely mentioned The following section will present the findings of the her husband, either in positive or negative terms, raising study, detailing the particular relational demands and a question about the strength of his presence in her life. challenges reported by participants when invited to reflect It was hard to tell if a long-term relationship did in fact on the impact of their work on their relationships. Five help her. Anna reported a stable and supportive relation- major themes emerged across the narratives of all six par- ship with a partner at home who did not work in the ticipants: (1) A radical split in their lives on both an exter- sector, but disclosed having a relationship with someone nal level, between home and the field, and on an internal else in the field as a coping strategy in the aftermath of a level, between different parts of their personality; (2) a traumatic incident a few months previously. Unlike conviction that the split was irreconcilable; (3) the Thomas, who felt that extra-marital relationships were long-standing search for belonging; (4) repetitively unpro- entirely acceptable, Anna appeared more conflicted by ductive relational patterns; (5) a sense of not knowing. behaviour that she viewed as “360 degree of who I usu- ally am”. A radical split The two single women interviewed approached the From the interviews, one could conclude that life for ex- issue of partners somewhat differently. Emma spoke patriate humanitarian workers is a mixed blessing. On the favourably about her support group of single female hu- one hand, they are privileged cosmopolitan professionals manitarian friends, but worried that the group had set up whose “transnational lives” (Fechter 2007)affordthema a “kind of self-fulfilling cycle” of singleness. At the same “world right to circulate unhindered” (Croucher 2012). In time, she seemed to assiduously avoid talking about men, stark contrast to “disadvantaged travellers” (Redfield indicating a continuing difficulty in fully encountering the 2012b) such as migrants, refugees and asylum seekers, the issue and associated feelings. I wondered also if it felt chal- people who undertake to provide assistance to these pop- lenging for her to name this difficulty to a male researcher. ulations stand to accrue a range of personal and financial Whether or not that was the case, the avoidance seemed benefits from their work, including frequent travel, an in- to reflect the overall difficulty in the sector of naming dis- teresting lifestyle, the opportunity to save money (Fechter cussing widely prevalent, yet deeply personal concerns. 2012a) or the cultivation of personal meaning (Thomas Sara appeared to have less difficulty in referencing the 2016). They are, of course, also potentially sustained by al- search for “theloveofmylife” but was unsure if moving truistic motives, even if those are inevitably mixed with back to the UK would help. She said friends were advising self-interest (Tassell and Flett 2011; Vaux 2001). At the her “to put down roots, in order to be able to meet some- same time, however, humanitarian workers are separated one and sustain it over the long-term”,butsaidshefelt from their family units and home friendship groups (Fech- “you can meet someone anywhere”. At the same time, she ter 2012b), while often living in unusual proximity with noted the “very shallow” nature of relationships in the field, co-workers in the field (i.e. confined to a compound under losing coherence in a way that seemed to imply, but not curfew). So, while the separation between work and home quite name, the sexual promiscuity that many field workers life is almost non-existent in the field (“You can hardly es- report as standing in for more sustained relationships. cape your colleagues,” according to Julian), the partici- All participants stressed the importance of maintaining pants in this present study spoke unanimously about the friendships, but there was variation between them as to challenge of coping with the much wider gulf between whether those friends were inside or outside the hu- their professional and personal lives. manitarian sector. Both Sara and Anna talked about the Snelling Journal of International Humanitarian Action (2018) 3:14 Page 8 of 15

importance of “personal” friendship circles back at camaraderie and shared understanding with colleagues. home, noting the intensity but transience of friendships On the other, they also expressed deep-seated needs for in the field. Jane and Emma on the other hand felt very continuity, belonging and connection in their home set- wedded to friends within the sector, looking to them for tings. For many though, these two equally valid realities validation and support. For the men, Thomas referred to could not be reconciled with each other, leaving them in a circle of friends but seemed much less intentional what the pioneer of systemic family therapy, Bateson et al. about maintaining those relationships and Julian spoke (1963), described as a double bind. Bateson and his col- somewhat poignantly about a wish to spend time with leagues initially coined the term in relation to the onset of close friends that “of course is not going to happen.” schizophrenia, describing the collapse of any ability to es- All of the participants felt it was important to maintain tablish a sense of order in the world (Gibney 2006). It has a physical home base, either in their country of origin or subsequently been extended as a framework for thinking in an adopted homeland, which ranged from owning a about impossible dilemmas and the distress they cause, “a house to maintaining a room in a friend’s apartment. choice between two states which are equally valued and They all also spoke about the need to balance time in so equally insufficient that a self-perpetuating oscillation the field with time at home and most were intentional by any active choice between them” Wilden and Wilson about ensuring that several months a year were spent (as cited by Redfield 2012b, 1976). Given the impossibility away from the field. Emma, for instance, had decided to of the double-bind, participants in the present study spend an extended period of time in the UK in response expressed feelings across the board of stuckness, not to a growing concern over what she saw as the impover- knowing, and even despair at ever being able to find a ishment of her personal life resulting from so much time solution. in the field: “I think it has been very important for men- Jane, for example, described a deep conflict between her tal health (to return to the UK), I kind of was craving love of the work and her wish to be with her children at that sense of normality.” home, but also expressed the fear that this left her feeling While every participant reported proactive measures as if she had some kind of “personality flaw”. This reflects to manage the external split between home bases and Gibney’s assertion (Gibney 2006) that the experience of field locations. Most participants (5/6) described a far double-bind is literally “crazy-making” (p. 48). Having de- more complex struggle to manage a perceived internal cided to spend some time back in the UK, Emma joked split between different parts of their personality. that she could be driven to becoming “that crazy angry person who may just want to go back to the field”, mask- Julian: “I have become a split personality. One person ing what seemed like a genuine concern with humour. who lives and moves in this world, and one person who lives and moves in that world.” Search for belonging If participants expressed frustration at how stuck they felt Anna said that she found it easy to switch between field in this double-bind, they also almost universally (5/6) and her “very, very different life” back at home, but imme- spoke about the way in which the humanitarian sector diately pointed to a split so complete that “I even look dif- had initially seemed to promise a deep sense of belonging ferent” in each place, suggesting quite a radical separation. and connection that it had ultimately failed to deliver. Almost every participant wondered which part of them Both Sara and Emma referred to their colleagues in fa- was “real”. Emma indicated a similar concern, describing milial terms. (In the author’s experience, both as a field the feeling of a “work mask” coming back on in the field. worker and a clinician who supports field workers, hu- It was striking how tiring it felt at times to listen to these manitarians often speak of their teams as surrogate family narratives, which triggered memories from my own career units.) For Sara, the shared experience of working for her of just how emotionally and physically draining it is to live team had enabled her to build “quite strong relationships”, with this kind of fragmentation, a reality supported by “basically you kind of have a ready-made family and Horney (1972) in her classic psychoanalytic study of the support network when you are away, because they are emotional toll of inner conflicts. in a similar situation to you”. Disappointingly, how- ever, relationships forged in the field could ultimately Double-bind “feel very shallow”.Emma,alsotalkedaboutfindinga However participants framed this split, the majority (5/6) “family”: expressed the view that it confronted them with a sense of contradictory and apparently irreconcilable demands in “I found my true tribe, these are my people!” their relational life. On the one hand, they expressed a sense of vocation, engagement and satisfaction in their As time had gone on, however, she said she had found work as humanitarians, including powerful feelings of herself feeling increasingly depleted, rather than Snelling Journal of International Humanitarian Action (2018) 3:14 Page 9 of 15

supported and nourished. “By year four and five, you are remembering the unbearable memory, then, the individ- like, ‘Now I am really fed up by this’.” ual goes through life simply repeating something of that The idea that humans engage in an on-going search experience instead Freud (1920/1957). While on one for relationships that feel reliable and enduring lies at level this can be seen as an attempt to master the ori- the heart of attachment theory (Holmes 2014). Bowlby ginal trauma Freud (1957a), it can also be a mechanism (1988), its pioneering thinker, believed that if children that simply condemns the individual to repeat and grow up an environment where caregivers are respon- reinforce it (Van der Kolk 1989). In the context of the sive, reliable and consistent in their care, they will de- present study, the theory of repetition compulsion sug- velop what he called a secure base, namely a sense of gests that rather than becoming passively stuck in a inner stability and confidence that emotional and phys- chronic struggle to connect, there may be something in ical needs can be met. In adult life, humans continue to the participants’ lives that drives them to actively and re- engage in secure base behaviour (Holmes 2001) at times peatedly seek that experience out. This idea will be dis- of stress in order to calm and soothe themselves. cussed at greater length below. Whether through positive and beneficial actions such as talking to friends, resting and reading or negative and Not knowing self-defeating strategies such as substance misuse, disor- Amidst the many challenges cited by participants, a re- dered eating and self-harm, people will seek to maintain curring theme (5/6) was quite simply the absence of an- a sense of security, whatever the consequences (Holmes swers, a sense of not knowing what to do. At different 2001). Viewing the narratives in the present study points in her interview, Emma described almost every through this lens, then, raises the idea that participants group of people in her life as either not knowing any- initially felt that the people and places accessed through thing or not wanting to know anything meaningful. Her humanitarian aid offered a reliable secure base. Their family, she said, “have not made an attempt to try and widely expressed (4/6) view, however, was that the understand more”. Friends back at home seemed only promised sense of security turned out to be less reliable interested in trivia. A therapist that she tried to see had than initially thought. appeared overwhelmed by the content and context of what she was bringing: “She could not professionally Repeating patterns handle the conversation”. Things were not much better Alongside the disappointment at not being able to sus- in the field. During the Ebola crisis, she said she felt “no tain a sense of belonging, a feeling that was expressed by one had a clue” and during another deployment in cen- half the participants was that this was a problem that tral Africa, “you really did not know what was going on”. was somehow self-perpetuating. Although participants In connection to the relational dilemmas that she faced, were able on the face of it to identify the dilemmas, in- Anna was similarly despairing: compatible demands and unfulfilled hopes, they also spoke as if they were stuck in a repeating pattern from “No one really has a solution, and you just kind of which they could not extricate themselves. hear a lot of sad stories about people just jumping On three occasions, Emma used the term “sucked from relationship to relationship, or from friendship into” to describe her sense of being pulled back into to friendship, so like no one really has a solution for it.” work environments, indicating powerful forces acting seemingly against her will. In terms of how this works in In most cases, it was striking how categorical partici- practice, she described an “echo chamber” created by pants were about not knowing. There was a concrete qual- her group of female colleagues that reinforced the com- ity to not having answers, as if these were challenges that pulsion to return to the field. Sara suggested that the hu- one could not be curious about in a way that might yield manitarian world actually attracts “people who do not possible solutions; as Allen put it, a problem of “too little belong”. The sense of inner displacement that they are imagination” (Allen 2013) when it comes to possible solu- already carrying then “gets replicated” by the perpetual tions. Anna, for instance, said that the only possible an- movement. Her perspective points to the possibility that swer in the future would be to leave the sector. Julian too, the repetitive sense of dislocation reported by partici- was certain that if humanitarian workers began a relation- pants may not, in fact, have been caused by working in ship with each other, one if not both would have to leave the sector, but be driven by personal factors that brought for the relationship to survive. It could be argued that this them into it. apparent certainty represented a mental stance knows as Freud (1914/1957) was one of the first to identify the psychic equivalence, in which inner thoughts and feelings way in which experiences in childhood that are experi- are equated with external reality (Allen 2013). enced as overwhelming or traumatic in some way are In this instance, the fact that answers do not seem pushed into the unconscious mind. Instead of available is taken to mean that answers do not exist, Snelling Journal of International Humanitarian Action (2018) 3:14 Page 10 of 15

indicative of a collapse in so-called reflective function- In terms of the present study, splitting and projective ing, or the “capacity to reflect on internal mental states defences were identifiable in two different forms. Partici- such as feelings, wishes, goals, and attitudes, with regard pants seemed either to present an idealised version of to both the self and others” (Fonagy et al. 2016). Difficul- themselves by splitting off and assigning undesirable ties with this kind of reflecting—also known as mentaliz- qualities to others (either colleagues or people back at ing—are known to be associated with vulnerability to home), or they created a split internally between a sup- depression (Lemma et al. 2011), but can also lead to a posedly strong capable part of themselves and more vul- variety of psychological problems (Bateman and Fonagy nerable and potentially needy part that needs to be 2012). It can then be argued that the sense of not know- suppressed. It was also interesting for me as the inter- ing represents not just a distracting annoyance for par- viewer to note where my sense that I was the recipient ticipants, but a significant risk factor to levels of of unconscious projections, otherwise known as coun- on-going resilience. ter-transference (Hinshelwood 1991), appeared to com- On a broader level, the view expressed by participants municate strong messages from the internal worlds of that—to borrow from Hollywood screenwriter William the participants. Goldman (2012)—“no one knows anything”, seemed to Jane’s narrative, for instance, seemed to indicate quite be a source of continuing anxiety. In psychodynamic profound splitting. She spoke in highly idealising terms terms, this could be framed as an almost complete ab- about life in the field: “I can make a big difference, it’s sence of containment (Bion 1962). Participants were fast-moving, it interests me”. She also spoke in highly clearly expressing anxiety, but they were also clearly de- denigrating terms about the people she met back at scribing a sense of there being no one around (individu- home: “You just want to eat your own eyeballs, they are ally or institutionally) who could help them make sense just so boring”. Although the tone of her narrative at of it. As Anna said: “No one really has a solution”.In times like this was half-joking, the violence of the lan- fact, at least half the participants seemed to be saying guage seemed to indicate a level of barely concealed that a reason they had volunteered to take part in the re- anger. At one point, she alluded to a wish that she could search was a hope that the conversation itself might in just sometimes just say, “For God’s sake, I am tired” and some way serve to shed some light on these dilemmas. have that heard and understood. But a more tyrannical part quickly took over: “But then you kind of do not Discussion want to sound like a winge-er, so you do not”. The present study found a high level of agreement Throughout the interview, I had a sense of being ur- among participants concerning a range of challenges gently asked to reassure and validate her struggle. “I mean that humanitarian workers face in their relational lives, you must have this feeling as well”, she said at one point. I which chimed with my own personal experience on mul- did indeed recognise the feeling and recalled with some tiple levels. As noted previously, the more practical, ex- discomfort the complex and contradictory mix of both ternal and conscious aspects of managing the demands victimised and persecutory feelings from life in the field. of life in the field have been well covered elsewhere Significantly for Jane, she had recently attended a work- (Dunkley 2018; McKay 2007; Pigni 2016). The aim of shop where space and time had been given to relational the following discussion, however, is to explore the find- dilemmas, which she said had been a revolutionary experi- ings through the lens of two overlapping bodies of psy- ence. So, while acknowledging the “superwoman” persona, chodynamic theory, psychoanalysis and attachment she seemed to have been finally given an opportunity to theory, with a view to drawing out the potentially un- express feelings of confusion and fatigue that were then conscious defences that humanitarians deploy to cope validated by others. In terms of the research question, it with these challenges. was striking that Jane had apparently carried personal and relational challenges of such magnitude for so long with- Splitting and projection out being able to openly discuss them. Her huge relief was The idea of a split has emerged repeatedly in different also noteworthy in that such an apparently simple solution ways in the present study, both as an externally imposed could feel like such an effective response to apparently division of life between the field and home and more in- very complex issues. ternal sense of a splitting of the personality between who they feel themselves to in work settings and at home. While both perspectives view the split as a de- Addiction to emergency mand to be met, field work, psychoanalytic theory also As noted in the findings, participants described the un- suggests that it might be an internally generated strategy comfortable challenge of feeling stuck in self-perpetuating for defending and protecting themselves against the psy- relational and behavioural patterns. The majority (4/6), chological threats that they face. however, also acknowledged an addictive quality to both Snelling Journal of International Humanitarian Action (2018) 3:14 Page 11 of 15

the experience of deploying to humanitarian contexts as has demonstrated that repeated exposure to inescapable well as to the kinds of interactions that they found there. stress releases endogenous opioids in the human body that For example, Thomas described getting “hooked to that provide soothing relief from anxiety. Naparstek (as cited by kind of emergency relationship” in the early years of his Thomas 2016, 2005) has also argued that individuals can career, something he felt he needed less of as he had got become addicted to their own biochemical responses to older. On a wider level, he used the same word talking trauma, setting up a self-perpetuating cycle of behavioural about getting “hooked when there’s a huge emergency and re-enactment. Taken together then, it can be concluded everyone wants to be part of it”. that emergency contexts have the capacity to help people Considering briefly the anthropology of humanitarian- manage and regulate their moods, either upwards or down- ism, Redfield (2012a) argued the urgent action demand wards, in ways that can, like any other chemical addiction, by states of emergency offer the “comforting justifica- become compulsive. tion” that inequalities in the world are temporary and can be redressed. In psychological terms, this idea could Attachment styles be re-framed as viewing the immediacy of emergency as Although beyond the scope of the present study, further a soothing distraction from the reality of underlying and detailed research is needed considering humanitarian re- much more intractable unmet needs. In psychodynamic lationships through the prism of attachment theory, the terms, intolerable inner dramas can be split off and framework for understanding the psychodynamics of ejected into the outside world, where they can be played interpersonal relationships pioneered by John Bowlby out as “transitional theatre” (McDougall 1982) in the and Mary Ainsworth (Holmes 2014). They and their suc- paradoxically less threatening external environment. cessors sought to understand how early experiences in According to Emma, “there’s a lot to be said around life shape the way people experience stress and develop the adrenalin buzz of also being at the heart of the big- relational strategies in order to cope (Holmes 2014). gest thing going on at the time.” Relationally, she de- These strategies become entrenched as attachment styles scribed it as “exciting (that) you are back with the same Ainsworth et al. (1978) or particular patterns of relating people, we are a good team, we are going to have a great that people carry into adulthood. A number of different time”. But straight away she framed this almost in terms attachment style classifications have been developed, but of an addict’s relapse: “You kind of managed to get away they can be summarised as secure, anxious, avoidant or from it, and then you get sucked straight back into it disorganised (Bifulco and Thomas 2013). again.” Anna too seemed to find something soothing in All the participants referenced experiences in early life emergency contexts: “My personality is very much kind that they felt has shaped their present approach to rela- of more comfortable doing the riskier deployments … tionships. Julian, Jane and Sara all referenced early expe- Generally, I am good in emergencies.” Interestingly, of riences of feeling like an “outsider”, albeit for different all the participants, only Anna referenced exposure to reasons, Thomas and Anna both spoke in rational, quite external trauma in the field as a stress factor, and even detached ways about relational dilemmas. In all cases, then, only as the trigger for a relational difficulty. their narratives indicated a tendency to distance them- So, far from being a source of difficulty for emergency aid selves from feelings and relationships, which would be workers, it appeared from the present study that the kinds consistent with a more avoidant attachment style. One of traumatised environments that they work in can actually participant, Emma, also expressed a sense of isolation in represent some kind of coping resource. Of the six partici- her family of origin—“not a kind of talking family”—but pants, four referred to field work as a “bubble”, somehow evidenced a more anxious attachment style, which in her removed from “normal” life. While this could be viewed as case manifested in an apparently greater need for exter- potentially problematic, the soothing qualities mentioned nal approval (Wei et al. 2005). above also indicate that the bubble is protective. This fits In-depth research is certainly needed fully exploring the with Steiner’s observations (Steiner 1993)thatsomepeople attachment styles of humanitarian workers. In terms of remain addictively wedded to avoidant defences that may the present study, however, it is simply worth noting that be uncomfortable on the one hand, but are maintained as a participants alluded to relational templates formed prior refuge, or psychic retreat, from harsh reality. to entering the sector. It could be argued that greater Alongside a psychodynamic reading of this repetition, the awareness of these patterns, developed through either for- addictivenatureoftheworkcanalsobeunderstoodin mal assessment or reflective practice, could equip humani- terms of physiological responses. As previously noted, sev- tarians to understand potential blocks to more fulfilling eral participants mentioned the (albeit temporary) benefits relationships and thus more effectively meet their rela- of the adrenalin released in emergency contexts, fuelling tional needs while in the field. It was certainly the case in feelings of excitement and competence. If the adrenalin my own experience that the stimulation and intensity of provides energy to give people a boost, Van der Kolk (1989) life in the field seemed for a while to compensate for a Snelling Journal of International Humanitarian Action (2018) 3:14 Page 12 of 15

deep sense of internal alienation. In subsequent personal The two participants who had sought counselling also therapy, I was able to trace this back to formative emo- evidenced er an understanding of the importance of tional challenges early in life. The decision to seek therapy, space to think through difficult challenges. Emma said however, was prompted by the realisation that while field that she had begun to find that friends were asking for life seemed to offer a way out of these attachment strug- her advice about contacting a therapist, which she saw gles, it seemed ultimately to avoid and entrench them. as evidence of slowly reducing stigma around seeking that kind of support. In the organisational setting, she The search for containment also echoed Jane in advocating for a “structured conver- Although psychological defences such as those described sation” about relational challenges in the work, a “forum above are deployed by individuals in an attempt to main- where we could talk about that with each other”. tain a sense of personal equilibrium, participants in the Sara felt that the current allowance in her organisation present study felt that they had nevertheless paid a high of six sessions of counselling was not enough and needed emotional price for working in the sector. Emma, who to be something “that we can tap into on a regular basis”. characterised the job as asking “for everything”,described She and two other participants also said that people were an increasing awareness over time of the impact. “By the unsure about using the available Employee Assistance fifth or sixth (deployment), you know … you are knack- Programme (EAP), an out-sourced service offering a tele- ered. Your ability to recharge and start again becomes phone helpline and a limited number of counselling ses- slow. I mean I kind of had a real sense of feeling lost.” The sions. Sara felt that more sustained “engagement over a eventual impact of this, she said, was to leave her with the longer term” was needed with “someone you can trust”,a feeling of being “a complete failure”, which prompted the wish consistent with the attachment concept of a safe decision to seek counselling and spend some time outside haven (Feeney and Woodhouse 2016) or the familiar and of the field. In line with Steiner’s theory that psychic de- consistent presence of an available caregiver. fences can work together as a refuge from the real world, In terms of other suggestions, Julian felt that more prep- Sara put it this way: “What I worry about is the longer I aration and guidance were needed at the beginning of the stay in this sector, … you get disconnected from reality”. humanitarian career and Emma argued that more creative For Julian, “it’s just too much change, too much is new, thinking was required around how workers might be able too much is different … And it costs so much energy to to share jobs or alternate assignments to give them enough take it in and try to make sense of it for yourself, that you time to create and sustain a secure base somewhere. really have no time to go and share that at any meaningful In different ways, participants were almost unanimously level.” And while Anna seemed basically content with her describing a wish for structured spaces offering contain- handling of the work, she also stated quite directly that ment of their anxieties, where difficult and potentially she thought she would eventually have to leave the sector contradictory thoughts and feelings about their relational if she really wanted to have a full family life of her own. worlds could be named and addressed. They did not spe- While the majority of participants (5/6) expressed a cify whether they felt this would make them more resilient sense of resignation in not being able to find solutions or productive, although it is well established that impover- to these anxieties, their narratives did in fact yield im- ished social support is contributory factor to burnout portant insights into what might help. Jane had recently among humanitarian workers (Brooks et al. 2015). This returned from a residential course where relationships in would support the idea that anything that might help and out of the field had been one of the main topics of strengthen the relationships of humanitarian workers discussion, even though the formal agenda did not in- would implicitly raise levels of resilience. On an organisa- clude this issue. For her, the “opportunity to talk about tional level, workplace teams where people are allowed to these things, and let off steam”, discovered quite by acci- express vulnerability and transparency without fear of re- dent, seems to have been nothing short of revolutionary. prisal have been demonstrated to become places of psy- She described a simple experience of naming relational chological safety (Edmondson 1999). Once this sense of difficulties in a protected space where she could show safety has been established, it then becomes a catalyst for vulnerability without fear of professional consequences. new learning, creativity, adaptability and high performance in team environments (Agarwal and Farndale 2017). As “But that might be all we need, just to go, stated previously, uncontained anxieties on an individual ‘That’s normal, this is aid work. What do you expect? level have also been shown to set up a range of unproduct- This is a thing. You’re not mad.” ive and defensive group behaviours in workplace settings, such as factionalization, meaningless busy-ness, avoidance Given the relief this provided, she expressed a wish of responsibility and a rigid focus on procedures at the ex- that her organisation could “provide people the safe pense of creative goals (Obholzer and Zagier Roberts spaces” to name, normalise and validate these struggles. 1994). Active containment of those anxieties then Snelling Journal of International Humanitarian Action (2018) 3:14 Page 13 of 15

facilitates a capacity on both individual and group levels external geographic level and an internal psychological to engage in coherent thinking and creative problem solv- one. The so-called double bind (Gibney 2006)ofthischal- ing (Obholzer and Zagier Roberts 1994;Steiner1993). In lenge leaves individuals unable to reflect creatively, or short, the reality of life and work can be faced and ad- mentalize (Fonagy et al. 2016), about possible solutions. dressed, rather than evaded and denied. This then drives them into erecting unconscious psychic As noted above, further research would be needed to defences against the anxiety that they feel, including split- firmly identify causal links between the relational chal- ting, projective identification (Klein 1946) and an addic- lenges experienced by humanitarians and their levels of tion to emergency (Gleiser 2003; Van der Kolk 1989). personal resilience and professional productivity. The Although unsure about how to resolve these anxieties, majority of participants in the present study, however, participants seemed to have benefited from finding pro- were unanimous in naming relational anxieties as a cen- tected and facilitated spaces—whether among peers or in tral preoccupation in their working lives. They also counselling—were their struggles and legitimate needs widely referenced the high emotional cost of these anx- could be named, acknowledged and processed in a way ieties and expressed the belief that these struggles, while that leaves them feeling heard and understood. The myr- ubiquitous in the sector, were not adequately understood iad challenges outlined by participants in this study un- or discussed (a reason that several participants gave for doubtedly chimed with my own experiences of life in the agreeing to participate in the study). It could then tenta- field and reflect on many levels the stories I hear regularly tively be concluded that a deeper understanding and in my clinical practice. I have been fortunate to find the processing of these anxieties—including their more un- spaces over the years where I have been able to identify conscious manifestations—would bolster a sense of per- and process these conflicts and dilemmas, which has led sonal self-awareness and efficacy and, by extension, me to a place of greater integration, satisfaction and well- strengthen levels of professional engagement. being in my life and relationships. It is my hope that this research will help other humanitarians do the same Conclusion and recommendations (Table 2). The present study has sought to address a broadly over- looked aspect of the humanitarian sector, namely the in- Endnotes ternal, subjective relational worlds of those who work in 1For the purposes of the present study, the terms it. The key finding of this study indicates a core area of re- “psychodynamic” and “psychoanalytic” are used lational challenge within this population is the division of interchangeably. life into apparently incompatible parts, on both an Abbreviations BMJ: British Medical Journal; BRCS: British Red Cross Society; CDC: Centers for Table 2 Practical recommendations Disease Control; EAP: Employee Assistance Programme; ICRC: International Arising from the narratives, the following practical recommendations for Committee of the Red Cross; INGO: International Non-Governmental Organ- the sector are offered: isation; ODI: Overseas Development Institute; UN: United Nations

1. Structured training and psycho-education during induction of Acknowledgements expatriate aid workers on the relational challenges of international I would like to thank Dr. Nikki Kiyimba and Dr. Christina Buxton of the humanitarian work, including opportunities for workers to assess Department of Social and Political Science at the University of Chester for areas of potential vulnerability and explore creative coping strategies. their consistent, engaged and responsive supervision during the research 2. Annual psychological assessments designed to review levels of and writing of this study. I would also like to thank the human resources resilience and coping, with a particular focus on the maintenance of adviser who helped me recruit the participants for this research. This project relational resources. could not have got off the ground without her facilitation and support. Sincere thanks, of course, go to the participants, who gave of their time to 3. Assessment with senior management of deployment rosters to allow speak openly and honestly about highly personal issues in their lives. I would workers enough time out of the field to build and maintain secure also like to thank Graham Fawcett of Thrive Worldwide for reading through relational support structures. the final draft. I am gratefully indebted to him for his valuable comments. 4. Regular facilitated workshops/retreats both at headquarters and in the field, where workers can reflect in a secure and protected space Funding on the impact of the work, share relational dilemmas, explore This study was self-funded by the author. possible ways forward, and create robust peer support networks. Availability of data and materials 5. Funding permitted, access to longer-term counselling support that Due to ethical considerations arising from the personal and highly sensitive allows individuals to maintain contact with the same therapist over nature of the data, the datasets supporting the conclusions of this article are time in order to promote a sense of relational reliability and continuity. not publicly available. Please contact author for data requests. 6. A follow-up project is recommended to monitor and evaluate the Author’s contributions impact of this kind of enhanced support on levels of engagement, The author read and approved the final manuscript. productivity and staff retention. Inviting a larger sample of aid workers to complete attachment style questionnaires as part of the ’ study could also provide a much clearer picture of relational needs, Author s information which could then be used to tailor training programmes. Mark Snelling is a counsellor, psychotherapist and psychosocial consultant working in private practice in London. He specialises in supporting humanitarian Snelling Journal of International Humanitarian Action (2018) 3:14 Page 14 of 15

aid workers but also works with a wide range of professional groups who operate Connorton E, Perry MJ, Hemenway D, Miller M (2012) Humanitarian relief workers in trauma-exposed settings. Prior to setting up his practice, he was a senior and trauma-related mental illness. Epidemiol Rev 34:145 clinician with InterHealth Worldwide, an international health charity providing Croucher S (2012) Privileged Mobility in an Age of Globality. Societies 2:1-13. medical and psychological support to aid agencies, mission organisations and https://doi.org/10.3390/soc2010001. government departments. He has also worked in the NHS. Before training as a Cyrulnik B (2009) Resilience: how your inner strength can set you free from the therapist, he was an international delegate of the British Red Cross Society, past. Penguin Books, London completing a number of short- and long-term assignments in areas of armed Danieli Y (1996) Who takes care of the caretakers? The emotional life of those conflict and natural disaster in Africa, Asia-Pacific and the Middle East. working with children in situations of violence. In: Appel RJ, Simon B (eds) Minefields in their hearts: the mental health of children in war and Competing interests communal violence. Yale University Press, New Haven, pp 189–205 The author declares that he has no competing interests. Davey E, Borton J, Foley M (2013) A history of the humanitarian system: western origins and foundations. HPG Working Paper ’ de Haan BB (1998) Emotional group debriefing of humanitarian aid workers: the Publisher sNote experience of ICRC Springer Nature remains neutral with regard to jurisdictional claims in published de Haan BB (2001) Humanitarian action and armed conflict: coping with stress maps and institutional affiliations. de Waal A (1997) Famine crimes: politics and the disaster relief industry in Africa. Indiana University Press, Bloomington Received: 3 April 2018 Accepted: 2 August 2018 Deci EL, Vansteenkiste M (2004) Self-determination theory and basic need satisfaction: understanding human development in positive psychology. Ricerche di Psicologia 27:23–40 References Dodds P (2017) UN peacekeepers in Haiti implicated in child sex ring Agarwal P, Farndale E (2017) High-performance work systems and creativity Duffield M (1994) Complex emergencies and the crisis of developmentalism implementation: the role of psychological capital and psychological safety. Institute of Development Studies Bulletin 25 Hum Resour Manag J 27:440–458. https://doi.org/10.1111/1748-8583.12148 Dunkley F (2018) Psychosocial support for humanitarian aid workers: a roadmap Ager A, Pasha E, & Yu G (2012). Stress, mental health, and burnout in national of trauma and critical incident care. Routledge, Abingdon humanitarian aid workers in Gulu, northern uganda. Journal of Traumatic ’ ’ Stress, 25. https://doi.org/10.1002/jts.21764. Easterley W (2007) The white man s burden: why the West s efforts to aid the rest Agishtein P, Brumbaugh C (2013) Cultural variation in adult attachment: the have done so much ill and so little good. Oxford University Press, Oxford impact of ethnicity, collectivism, and country of origin. J Soc Evol Cult Edmondson A (1999) Psychological safety and learning behavior in work teams. – Psychol 7:384–405. https://doi.org/10.1037/h0099181 Adm Sci Q 44:350 383. https://doi.org/10.2307/2666999 Ainsworth MDS, Blehar MC, Waters E, Wall S (1978) Patterns of attachment: a Ehrenreich J (1999). The Humanitarian Companion: A guide for international aid, psychological study of the strange situation. Erlbaum, Hillsdale development and human rights workers. ITDG Publishing, Bradford. Alayarian A (2011) Trauma, torture and dissociation: a psychoanalytic view. Karnac Ehrenreich JH, Elliott TL (2004) Managing stress in humanitarian aid workers: a ’ Books, London survey of humanitarian aid agencies psychosocial training and support of – Allen J (2013) Mentalizing in the development and treatment of attachment staff. Peace Confl: J Peace Psychol 10:53 66. https://doi.org/10.1207/ trauma. Karnac Books, London s15327949pac1001_4 Antares Foundation (2012) Managing stress in humanitarian workers: guidelines Erdman P, Ng K-M (2010) Attachment: expanding the cultural connections, vol for good practice, 3rd edn Book, Whole. Routledge, London Bateman A, Fonagy P (2012) Handbook of mentalizing in mental health practice. Eriksson CB, Kemp HV, Gorsuch R, Hoke S, Foy DW (2001) Trauma exposure and American Psychiatric Publishing, Arlington PTSD symptoms in international relief and development personnel. J Trauma – Bateson G, Jackson DD, Haley J, Weakland J (1963) Toward a theory of Stress 14:205 212. https://doi.org/10.1023/A:1007804119319 schizophrenia. In: Smelser NJ, Smelser WT (eds) Personality and social Eriksson CB et al (2009) Social support, organisational support, and religious systems. Wiley, Hoboken, pp 172–187. https://doi.org/10.1037/11302-016 support in relation to burnout in expatriate humanitarian aid workers mental – Berk JH (1998) Trauma and resilience during war: a look at the children and health. Relig Cult 12:671 686. https://doi.org/10.1080/13674670903029146 humanitarian aid workers of Bosnia. Psychoanal Rev 85:639 Eriksson CB et al (2013) Predeployment mental health and trauma exposure of Berzoff J, Kita E (2010) Compassion fatigue and countertransference: two different expatriate humanitarian aid workers: risk and resilience factors. Traumatology – concepts. Clin Soc Work J 38:341–349. https://doi.org/10.1007/s10615-010-0271-8 19:41 48. https://doi.org/10.1177/1534765612441978 Bifulco A, Thomas G (2013) Understanding adult attachment in family Etherington K (2004) Becoming a reflexive researcher: using ourselves in research, relationships: research, assessment and intervention, vol Book, Whole. vol Book, Whole. Jessica Kingsley, London; Philadelphia Routledge, London Fawcett J (2003) Stress and trauma handbook: strategies for flourishing in Bion W (1959) Attacks on linking. Int J Psychoanal 40:308–315 demanding environments. World Vision International, Monrovia Bion W (1962) A theory of thinking. Int J Psychoanal 33:306–310 Fechter A-M (2007) Transnational lives: expatriates in Indonesia. Routledge, Abingdon Bjerneld M, Lindmark G, McSpadden LA, Garrett MJ (2006) Motivations, concerns, Fechter A-M (2012a) ‘Living well’ while ‘doing good’? (missing) debates on and expectations of Scandinavian health professionals volunteering for altruism and professionalism in aid work. Third World Q 33:1475–1491. humanitarian assignments. Disaster Manag Response 4:49–58 https://doi.org/ https://doi.org/10.1080/09700161.2012.698133 10.1016/j.dmr.2006.01.002 Fechter A-M (2012b) The personal and the professional: aid workers’ relationships Blanchetiere P (2006) Resilience of humanitarian workers and values in the development process. Third World Q 33:1387–1404. Bowlby J (1988) A secure base, vol Book, Whole, New edn. Abingdon: Routledge https://doi.org/10.1080/01436597.2012.698104 Ltd Feeney BC, Woodhouse SS (2016) Caregiving. In: Cassidy J, Shaver P (eds) Breuer J, Freud S (1955) Studies on Hysteria. In: Strachey J (ed) Standard edition, Handbook of attachment: theory, research, and clinical applications, 3rd edn. vol 2. Hogarth Press, London (Original work published 1895) The Guildford Press, New York Brooks SK, Dunn R, Sage CAM, Amlôt R, Greenberg N, Rubin GJ (2015) Risk and Fonagy P et al (2016) Development and validation of a self-report measure of resilience factors affecting the psychological wellbeing of individuals mentalizing: the reflective functioning questionnaire. PLoS One 11. https:// deployed in humanitarian relief roles after a disaster. J Ment Health 24:385– doi.org/10.1371/journal.pone.0158678 413. https://doi.org/10.3109/09638237.2015.1057334 Freud A (1968a) The ego and the mechanisms of defence. The International Cain K, Postlewait H, Thompson A (2005) Emergency sex (and other desperate Psycho-Analytical Libray Hogarth Press/Institute of Psychoanalysis, London measures): true stories from a war zone. Ebury Press, London Freud S (1940) Splitting of the ego in the process of defence. In: Strachey J (ed) Cardozo BL et al (2012) Psychological distress, depression, anxiety, and burnout Standard edition, vol 23. Hogarth Press, London, pp 271–278 among international humanitarian aid workers: a longitudinal study. Public Freud S (1957a) Beyond the pleasure principle. In: Strachey J (ed) Standard Libr Sci 7. https://doi.org/10.1371/journal.pone.0044948 edition, vol 18. Hogarth Press, London (Original work published 1920) Casement P (2014) On learning from the patient, vol Book, Whole, Classic edn. Freud S (1957b) Mourning and melancholia. In: Strachey J (ed) Standard edition, Routledge, Hove; New York vol 14. Hogarth Press, London, pp 243–258 (Original work published 1917) Snelling Journal of International Humanitarian Action (2018) 3:14 Page 15 of 15

Freud S (1957c) On narcissism: an introduction. In: Strachey J (ed) Standard edition, Orbinski J (2008) An imperfect offering: dispatches from the medical frontline. vol 14. Hogarth Press, London, pp 73–102 (Original work published 1914) Text Publishing Company, Melbourne Freud S (1968b) Repression. In: Strachey J (ed) Standard edition, vol 14. Hogarth Ozbay F, Johnson DC, Dimoulas E, Morgan CA, Charney D, Southwick S (2007) Press, London, pp 141–158 (Original work published 1915b) Social support and resilience to stress: from neurobiology to clinical practice. Frosh S, Emerson PD (2005) Interpretation and over-interpretation: disputing the Psychiatry 4:35 meaning of texts. Qual Res 5:307–324. https://doi.org/10.1177/ Papadopoulos R (2002) Therapeutic care for refugees: no place like home. Karnac 1468794105054457 Books, London Frosh S, Saville Young L (2008) Psychoanalytic approaches to qualitative People in Aid (2003) Code of best practice in the management and support of psychology. In: Willig C, Stainton-Rogers W (eds) Qualitative research in aid personnel, 2nd edn. London: People in Aid psychology. SAGE Publications, London Pigni A (2016) The idealist’s survival kit: 75 simple ways to prevent burnout. Gibney P (2006) The double bind theory: still crazy-making after all these years. Parallax Press, Berkely Psychother Australia 12:48–55 Porter B, & Emmens B. (2009). Approaches to staff care in international ngos. Gleiser KA (2003) Psychoanalytic perspectives on traumatic repetition. J Trauma Retrieved from London: https://www.chsalliance.org/files/files/Resources/ Dissociation 4:27–47. https://doi.org/10.1300/J229v04n02_03 Articles-and-Research/approaches-to-staff-care-ininternational-ngos.pdf. Goldman W (2012) Adventures in the screen trade. Grand Central Publishing, New York Accessed 5 Jan 2018. Hawkins P, Shohet R (2012) Supervision in the helping professions, vol Book, Quevillon RP, Gray BL, Erickson SE, Gonzalez ED, Jacobs GA (2016) Helping the Whole, 4th edn. Open University Press, Maidenhead helpers: assisting staff and volunteer workers before, during, and after – Heimann P (1950) On Countertransference. International Journal of disaster relief operations. J Clin Psychol 72:1348 1363. https://doi.org/10. Psychoanalysis. 31:81–84. 1002/jclp.22336 Hinshelwood RD (1991) A dictionary of Kleinian thought, 2nd edn. Free Redfield P (2012a) Humanitarianism. In: Fassin D (ed) A companion to moral – Association, London anthropology. Wiley-Blackwell, Malden, pp 451 467 Hollway W, Jefferson T (2013) Doing qualitative research differently: a psychosocial Redfield P (2012b) The unbearable lightness of ex-pats: double binds of – approach, vol Book, Whole, 2nd edn. SAGE Publications, London humanitarian mobility. Cult Anthropol 27:358 382. https://doi.org/10.1111/j. Holmes J (2001) The search for the secure base: attachment theory and 1548-1360.2012.01147.x psychotherapy, vol Book, Whole. Brunner/Routledge, London; Philadelphia Reich JW, Zautra A, Hall JS (2012) Handbook of adult resilience, vol Book, Whole. Holmes J (2013) Using psychoanalysis in qualitative research: Guilford, New York countertransference-informed researcher reflexivity and defence mechanisms Riddell R (2008) Does foreign aid really work? Oxford University Press, New York in two interviews about migration. Qual Res Psychol 10:160–173. https://doi. Seligman M (1990) Learned optimism: how to change your mind and your life. org/10.1080/14780887.2011.586451 Vintage Books, New York Silverman C (2005) Misfits, mercenaries and missionaries [blog post]. http:// Holmes J (2014) John Bowlby and attachment theory, vol Book, Whole, 2nd edn. ordinary.blogs.com/clips/aidworkers.pdf Routledge, Taylor & Francis Group, New York; London Skeoch K, Stevens GJ, Taylor M (2017) Future role aspirations, achievement Horney K (1972) Our inner conflicts: a constructive theory of neurosis. W. W. motivations and perceptions of personal help-seeking among humanitarian Norton & Company, New York aid trainees. J Int Humanitarian Action 2:1–10. https://doi.org/10.1186/ Inter-Agency Regional Analysts Network (2017) The future of aid: INGOs in 2030 s41018-017-0027-y Joseph B (1985) Transference: the total situation. Int J Psychoanal 66:447–454 Slim H (1995) The continuing metamorphosis of the humanitarian practitioner: Karray A, Coq J-M, Bouteyre E (2017) Delivering online clinical interviews with some new colours for an endangered chameleon. Disasters 19:110 NGO workers in humanitarian and cross-cultural contexts. Int Perspect Stack Sullivan H (1968) The interpersonal theory of psychiatry. W. W. Norton & Psychol 6:115–131. https://doi.org/10.1037/ipp0000069 Company, New York ‘ ’ Kim HS, Sherman DK (2007) Express yourself : culture and the effect of self- Steiner J (1993) Psychic retreats: pathological organizations in psychotic, neurotic – expression on choice. J Pers Soc Psychol 92:1 11. https://doi.org/10.1037/ and borderline patients. Routledge, Hove 0022-3514.92.1.1 Tassell N, Flett R (2007) Obsessive passion as an explanation for burnout: an – Klein M (1946) Notes on some schizoid mechanisms. Int J Psychoanal 27:99 110 alternative theoretical perspective applied to humanitarian work. Aust J Lemma A, Target M, Fonagy P (2011) Brief dynamic interpersonal therapy: a Rehabil Counsel 13:101–114 ’ clinician s guide. Oxford University Press, Oxford Tassell N, Flett R (2011) Motivation in humanitarian health workers: a self- Macnair R (1995) Room for Improvement. Overseas Development Institute, determination theory perspective. Dev Pract 21:959–973. https://doi.org/10. McCall M, Salama P (1999) Selection, training, and support of relief workers: an 1080/09614524.2011.590889 – occupational health issue. BMJ 318:113 116. https://doi.org/10.1136/bmj.318. Thomas R (2016) Psychological stress: aid workers in complex humanitarian 7176.113 emergencies. Lambert Academic Publishing, Saarbrucken McCormack L, Joseph S (2013) Psychological growth in humanitarian aid Tummala-Narra P (2015) Cultural competence as a core emphasis of personnel: reintegrating with family and community following exposure to psychoanalytic psychotherapy psychoanalytic. Psychology 32:275–292. war and genocide. Community Work Fam 16:147–163. https://doi.org/10. https://doi.org/10.1037/a0034041 1080/13668803.2012.735478 UNHCR (2001) Managing the stress of humanitarian emergencies McDougall J (1982) Theatres of the mind: illusion and truth on the Vallerand RJ et al (2003) Les passions de l’âme: on obsessive and harmonious psychoanalytic stage. Free Association Books, London passion. J Pers Soc Psychol 85:756–767. https://doi.org/10.1037/0022-3514.85. McKay L (2007) On the road again: coping with travel and re-entry stress. 4.756 Headington institute. http://headington-institute.org/files/travel-stress_ Van der Kolk BA (1989) The compulsion to repeat the trauma. Re-enactment, moduletemplate2_edited_82539.pdf. Accessed 16 Jan 2018 revictimization, and masochism. Psychiatr Clin North Am 12:389 Mesman J, van Ijzendoorn M, Sagi-Schwartz A (2016) Cross-cultural patterns of Vaux T (2001) The selfish altruist: relief work in famine and war. Earthscan, attachment: universal and contextual dimensions. In: Cassidy J, Shaver P (eds) London Handbook of attachment: theory, resarch, and clinical applications, 3rd edn. Volkan V (2017) Immigrants and refugees: trauma, perennial mourning, prejudice, The Guildford Press, New York/London and border psychology. Karnac Books, London Mitchell S (2000) Relationality: from attachment to intersubjectivity. Routledge, Wall S (2008) Easier said than done: writing an autoethnography. Int J Qual London Methods 7:38–53. https://doi.org/10.1177/160940690800700103 Moyo D (2010) Dead aid: why aid is not working and how there is another way Wei M, Mallinckrodt B, Larson LM, Zakalik RA (2005) Adult attachment, depressive for Africa Penguin, London symptoms, and validation from self versus others. J Couns Psychol 52:368– Naparstek B (2005) Invisible heroes: survivors of trauma and how they heal. 377. https://doi.org/10.1037/0022-0167.52.3.368 Bantam Books, New York Wilden A, Wilson T (1976) The double bind: logic, magic, and economics. In: O’Neill S (2018) Top Oxfam staff paid Haiti survivors for sex Sluzki C, Ransom D (eds) Double bind: the foundation of communicational Obholzer A, Zagier Roberts V (1994) The unconscious at work: individual and approach to the family. Grune and Stratton, New York, pp 263–286 organizational stress in the human services. Routledge, London